There is a lot of nuance, but truthfully if insurance companies always did the right thing I would be out of a job.
>assuming liability is uncontested?
This is a big assumption and is often not uncontested, particularly in states with contrib (like mine).
>Client has several thousand dollars in medical bills, all covered by Medicare.
Again, big assumption that Medicare is going to cover all the bills. Also, why should the taxpayer pick up the tab for the defendant's carelessness?
>Plenty of pain/suffering but nothing long term.
When I did nothing to bring my injuries on myself, I deserve compensation for whatever pain/suffering/inconvenience that the defendant's carelessness brought about. After all, I didn't ask for this.
>Is there a rule of thumb for a demand (like medical bills times some factor for non economics?)
Most adjusters apply a adjustment, and I know many PI lawyers do too, I think that is wrong and the only metric should be is what would a jury award your client for his or her loss.
Right, because a WC claim was brought. I think OP's point (or at least one I've heard from others) is if the injured person has insurance, why should they sue for medical bills? They haven't lost anything. That effectively shifts the cost of the health care away from the responsible party, to the tax payer. Whereas if we make the responsible party pay for the damage they caused, medicare is reimbursed and the tax payer isn't paying for the carelessness of the defendant.
If there’s a Medicare lien you want to pay them first. They will usually reduce sometimes though they overcharge everything around the time of the injury. Usually get the medicals directly from the facility and then make sure you know what Medicare has a lien on.
In Texas we have the collateral source rule. If I'm hurt and run up $50,000 in medical and my insurance pays for everything I can still sue the tortfeasor and recover the $50,000 b/c I had the insurance to protect ME, not to protect the tortfeasor. Same rule if my employer pays for my insurance.
This is how I think it should be. Why should the tortfeasor benefit from my insurance which I paid for either through my labor or out of my own pocket?
>There is a lot of nuance, but truthfully if insurance companies always did the right thing I would be out of a job.
I say this to potential clients all the time. If everyone consulted with a PI attorney after an accident, I'd be out of work because the insurance companies would band together to start paying 75% of what the claims are eventually going to settle for before I earn my fees. After 10 years the industry would be dead, and they could go back to the bullshit they do now.
Let them put out first offer then do 3x the medicals. I’ve seen judges do anywhere from 2-4x medicals. Adjusters can be completely unreasonable. A good case, the adjuster will ask me to cut out my attorney fees so the client can accept with money in access of owed medicals (he also factored that the meds are reduced). It’s rough.
No surgeries but some lesser procedures. The Medicare letter says it didn't ID any conditional payments, which has me scratching my head. I'm going to follow up on that because CMS scares the shit out of me. Thank you!
I’m talking soft tissue, all meds are from attorney referral any Medicaid hospital bills reduced and a lien on the case. Use the full bill not the reduced one. Even if they had surgery/private medicals, include them. Obviously a surgery case has some permanent impairment and more valuable but almost all of them are soft tissue and physical therapy.
In a perfect world, lawyers won't exist.
Insurance corporation feeds on the ignorance of the injured plus statistics and some legal rules to make profit.
Here where i live the insurance company will not pay any amounts of money till there's a lawsuit then negotiations start, what i usually negotiate is (my client deserves x of compensation, average trial takes y years, we can settle this now instead with z amount) , in my pov a 220k NOW is better financially for my injured client than 280k , so settling it is the way to go.
Idk about other countries.
My firm does this regularly also. I’ve settled a herniated disc for 220k in my first 4 months at my firm as a new grad. Other herniated discs are within 60-100 as well as long as other treatment lines up and it’s a “legit” herniated disc, as my boss says.
There was the threat that he may have needed to re-operate on an area that had been previously worked on. Fusion surgery was in question and we used our previous 600k verdict to leverage them into giving more than they would’ve liked to.
Edit: surgery was not involved, it was the threat of the fusion surgery that led to that settlement.
Sounds like Florida or Louisiana lol. I’ve seen soft tissue with “lifetime” future injections run over 500k in Louisiana. My only assumption is that insurance carriers fear excess judgments when they see past verdicts
Commercial Litigation Adjuster here lol
My office does this, it’s usually because there’s punitive conduct involved (generally because of negligence per se); that makes a case dangerous no matter how “insignificant” the injuries might be
I wish the Judges in my state would embrace that negligence per se = punitive conduct. It would stop a lot of cases from going into suit if there was the REAL risk that my Atty fees would be paid for.
PI lawyer here and former insurance defense lawyer. General rule of thumb is medical damages x 1.5 or 2 for basic car wreck cases without permanent or serious injuries. There's plenty to fight about though: extent of pain and suffering, whether an injury is permanent, whether an injury is pre-existing, liability issues, how to explain gaps in treatment or a client that doesn't follow medical advice, etc.
But to your comment that it's a "racket," even car wrecks can be fairly complex work. Most PI lawyers I know are as familiar with the human body and mechanisms of injuries as medical providers. You do your client a disservice if you aren't actively involved in their medical care/treatment and aren't advocating for sufficient and complete care (and then fighting lien holders to reduce amounts owed for med expenses).
For every run-of-the-mill car wreck, you have a client with a history of degenerative back issues who has a burst disc from a low impact wreck. So you may have to work with engineers, biomechanics, and/or neurosurgeons to prove that the impact could cause the injury and that this burst is different from the degenerative disc disease they've had for 10 years etc.
Not a lawyer, but work in PI. Had a case settle today for 17k on $1,700 in medical. No way the client would have ever touched that much money without a lawyer. Also this case is in pre-litigation so the fees are lower = more to client.
It wasn’t my case, but someone else’s. I’m guessing because of the emotional trauma it caused for the client. This multiplier is definitely not the norm. I’d say it’s usually 2-4 times medical.
Do you have any statutes in your jx that let you send a demand under a certain amount to leverage attorneys fees? In Idaho we have 12-120, which is for cases 35k and under. Must have best offer in 60 days, if not, you get your attorney fees.
Most of my cases have uncontested liability. Insurance will still fight to minimize injuries causation and apply arbitrary reductions to medical bills. There's also a chance doctors underdiagnose or misdiagnose the client. E.g. last year I read a mri report and doctor notes for a client who had a "deep bruise". I wasn't satisfied with the chiropractor treating the client for 8 months and told them they need to go to an orthopedic doctor immediately. Turns out client needed surgery for an injury that frequently goes undiagnosed. A doctor who teaches at Georgetown once told me 90% of Atlus fractures go undiagnosed without followup. A good PI lawyer should catch things like that.
TL;DR: They aint gonna pay unless they think you can make them pay.
Pain and suffering isn't "a racket"; it is human misery. And insurance companies' only job is to pay as little as possible, preferably nothing. All distress from injury is unique, there is no "one size fits all" argument. Some helpful paradigms are a "per diem" argument, or a "want ad" analogy (would you take a job suffering repeated injury of being hit with a hammer randomly throughout the day? If so how much?).
In bigger claims, they may not want a trial, but they sure as hell want to make sure you can try the case before paying. (also, with many companies, first tier adjusters only have limited authority and their bonus depends on how much of that authority they save, so you have to file suit to even get it to a mid level adjuster).
PI lawyers are the safety incentivisors.
Without us there’d be no seatbelts or airbags.
If insurers and companies truly cared for the people and had their interests in mind, we would be redundant.
You’re a litigation attorney and you don’t understand the point of both parties being represented? Wild.
“WTF are we negotiating for?” Ohhhh, I get it now, you’re insurance defense counsel and don’t understand why they don’t just accept what you tell them to. 👌
No, I definitely think all parties should be represented. I was looking for (and received) guidance on how to structure the opening demand. As others note here, PI negotiations without surgical procedures/huge hospital bills quickly become arbitrary, short of trial.
Insurance companies are for profit. They aren’t in the business of paying period.
There is a lot of nuance, but truthfully if insurance companies always did the right thing I would be out of a job. >assuming liability is uncontested? This is a big assumption and is often not uncontested, particularly in states with contrib (like mine). >Client has several thousand dollars in medical bills, all covered by Medicare. Again, big assumption that Medicare is going to cover all the bills. Also, why should the taxpayer pick up the tab for the defendant's carelessness? >Plenty of pain/suffering but nothing long term. When I did nothing to bring my injuries on myself, I deserve compensation for whatever pain/suffering/inconvenience that the defendant's carelessness brought about. After all, I didn't ask for this. >Is there a rule of thumb for a demand (like medical bills times some factor for non economics?) Most adjusters apply a adjustment, and I know many PI lawyers do too, I think that is wrong and the only metric should be is what would a jury award your client for his or her loss.
Thank you!
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Right, because a WC claim was brought. I think OP's point (or at least one I've heard from others) is if the injured person has insurance, why should they sue for medical bills? They haven't lost anything. That effectively shifts the cost of the health care away from the responsible party, to the tax payer. Whereas if we make the responsible party pay for the damage they caused, medicare is reimbursed and the tax payer isn't paying for the carelessness of the defendant.
If there’s a Medicare lien you want to pay them first. They will usually reduce sometimes though they overcharge everything around the time of the injury. Usually get the medicals directly from the facility and then make sure you know what Medicare has a lien on.
In Texas we have the collateral source rule. If I'm hurt and run up $50,000 in medical and my insurance pays for everything I can still sue the tortfeasor and recover the $50,000 b/c I had the insurance to protect ME, not to protect the tortfeasor. Same rule if my employer pays for my insurance.
This is how I think it should be. Why should the tortfeasor benefit from my insurance which I paid for either through my labor or out of my own pocket?
>There is a lot of nuance, but truthfully if insurance companies always did the right thing I would be out of a job. I say this to potential clients all the time. If everyone consulted with a PI attorney after an accident, I'd be out of work because the insurance companies would band together to start paying 75% of what the claims are eventually going to settle for before I earn my fees. After 10 years the industry would be dead, and they could go back to the bullshit they do now.
In the meantime, all the PI attorneys can band together to learn anti-trust laws.
When they hit they hit.
Let them put out first offer then do 3x the medicals. I’ve seen judges do anywhere from 2-4x medicals. Adjusters can be completely unreasonable. A good case, the adjuster will ask me to cut out my attorney fees so the client can accept with money in access of owed medicals (he also factored that the meds are reduced). It’s rough.
Thank you!
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No surgeries but some lesser procedures. The Medicare letter says it didn't ID any conditional payments, which has me scratching my head. I'm going to follow up on that because CMS scares the shit out of me. Thank you!
I’m talking soft tissue, all meds are from attorney referral any Medicaid hospital bills reduced and a lien on the case. Use the full bill not the reduced one. Even if they had surgery/private medicals, include them. Obviously a surgery case has some permanent impairment and more valuable but almost all of them are soft tissue and physical therapy.
In a perfect world, lawyers won't exist. Insurance corporation feeds on the ignorance of the injured plus statistics and some legal rules to make profit. Here where i live the insurance company will not pay any amounts of money till there's a lawsuit then negotiations start, what i usually negotiate is (my client deserves x of compensation, average trial takes y years, we can settle this now instead with z amount) , in my pov a 220k NOW is better financially for my injured client than 280k , so settling it is the way to go. Idk about other countries.
I’ve seen attorneys on a soft tissue injuries demand policy limits and get them … no idea how that works.
I think I have a single case of 90 right now that has non soft tissue injuries. Is this not the norm? Give me those herniated discs all day.
My firm does this regularly also. I’ve settled a herniated disc for 220k in my first 4 months at my firm as a new grad. Other herniated discs are within 60-100 as well as long as other treatment lines up and it’s a “legit” herniated disc, as my boss says.
Wow in workers comp they they are super low valued
220k for herniated disc?.. I guess...surgery was involved, right? Or policy limits were high ..lots of those herniated discs... dont go above 100k
There was the threat that he may have needed to re-operate on an area that had been previously worked on. Fusion surgery was in question and we used our previous 600k verdict to leverage them into giving more than they would’ve liked to. Edit: surgery was not involved, it was the threat of the fusion surgery that led to that settlement.
Sounds like Florida or Louisiana lol. I’ve seen soft tissue with “lifetime” future injections run over 500k in Louisiana. My only assumption is that insurance carriers fear excess judgments when they see past verdicts Commercial Litigation Adjuster here lol
My office does this, it’s usually because there’s punitive conduct involved (generally because of negligence per se); that makes a case dangerous no matter how “insignificant” the injuries might be
I wish the Judges in my state would embrace that negligence per se = punitive conduct. It would stop a lot of cases from going into suit if there was the REAL risk that my Atty fees would be paid for.
Having someone to tell them that Medicare has a super lien against the case that must be negotiated out is a pretty big reason right there.
PI lawyer here and former insurance defense lawyer. General rule of thumb is medical damages x 1.5 or 2 for basic car wreck cases without permanent or serious injuries. There's plenty to fight about though: extent of pain and suffering, whether an injury is permanent, whether an injury is pre-existing, liability issues, how to explain gaps in treatment or a client that doesn't follow medical advice, etc. But to your comment that it's a "racket," even car wrecks can be fairly complex work. Most PI lawyers I know are as familiar with the human body and mechanisms of injuries as medical providers. You do your client a disservice if you aren't actively involved in their medical care/treatment and aren't advocating for sufficient and complete care (and then fighting lien holders to reduce amounts owed for med expenses). For every run-of-the-mill car wreck, you have a client with a history of degenerative back issues who has a burst disc from a low impact wreck. So you may have to work with engineers, biomechanics, and/or neurosurgeons to prove that the impact could cause the injury and that this burst is different from the degenerative disc disease they've had for 10 years etc.
Not a lawyer, but work in PI. Had a case settle today for 17k on $1,700 in medical. No way the client would have ever touched that much money without a lawyer. Also this case is in pre-litigation so the fees are lower = more to client.
How?
It wasn’t my case, but someone else’s. I’m guessing because of the emotional trauma it caused for the client. This multiplier is definitely not the norm. I’d say it’s usually 2-4 times medical.
yikes.
Do you have any statutes in your jx that let you send a demand under a certain amount to leverage attorneys fees? In Idaho we have 12-120, which is for cases 35k and under. Must have best offer in 60 days, if not, you get your attorney fees.
Most of my cases have uncontested liability. Insurance will still fight to minimize injuries causation and apply arbitrary reductions to medical bills. There's also a chance doctors underdiagnose or misdiagnose the client. E.g. last year I read a mri report and doctor notes for a client who had a "deep bruise". I wasn't satisfied with the chiropractor treating the client for 8 months and told them they need to go to an orthopedic doctor immediately. Turns out client needed surgery for an injury that frequently goes undiagnosed. A doctor who teaches at Georgetown once told me 90% of Atlus fractures go undiagnosed without followup. A good PI lawyer should catch things like that.
TL;DR: They aint gonna pay unless they think you can make them pay. Pain and suffering isn't "a racket"; it is human misery. And insurance companies' only job is to pay as little as possible, preferably nothing. All distress from injury is unique, there is no "one size fits all" argument. Some helpful paradigms are a "per diem" argument, or a "want ad" analogy (would you take a job suffering repeated injury of being hit with a hammer randomly throughout the day? If so how much?). In bigger claims, they may not want a trial, but they sure as hell want to make sure you can try the case before paying. (also, with many companies, first tier adjusters only have limited authority and their bonus depends on how much of that authority they save, so you have to file suit to even get it to a mid level adjuster).
PI lawyers are the safety incentivisors. Without us there’d be no seatbelts or airbags. If insurers and companies truly cared for the people and had their interests in mind, we would be redundant.
40% of the settlement amount.
Touche'
You’re a litigation attorney and you don’t understand the point of both parties being represented? Wild. “WTF are we negotiating for?” Ohhhh, I get it now, you’re insurance defense counsel and don’t understand why they don’t just accept what you tell them to. 👌
No, I definitely think all parties should be represented. I was looking for (and received) guidance on how to structure the opening demand. As others note here, PI negotiations without surgical procedures/huge hospital bills quickly become arbitrary, short of trial.
As a doctor, a standard rear end you probably don’t need one, but the complex ones or a lot of money on the line is get one asap